Attachment in close relationships and glycemic outcomes in children with type 1 diabetes
Simona Klemenčič1, Jasna Klara Lipovšek2, Anja Turin2,3
1Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia. simona.klemencic@kclj.si.
Insights
Attachment styles impact type 1 diabetes (T1D) outcomes in children. Secure girls had higher HbA1c, while insecure parent attachment worsened glycemic control in boys, affecting HbA1c and time in range (TIR).
Area of Science:
- Psychology
- Endocrinology
- Pediatrics
Background:
- Child attachment to parents, parent attachment style, and morning cortisol levels may influence diabetes management in children with type 1 diabetes (T1D).
- Glycemic outcomes include average glycated hemoglobin (HbA1c), HbA1c variability, and time in range (TIR).
Purpose of the Study:
- To investigate the relationship between child-parent attachment, parent attachment style, and cortisol levels with glycemic outcomes in children with T1D.
- To identify predictors of average HbA1c, HbA1c variability, and TIR over a 4-year period.
Main Methods:
- 101 children with T1D and a parent completed attachment assessments (Child Attachment Interview; Relationship Structures Questionnaire).
- Cortisol levels were measured, and HbA1c and TIR data were collected over 4 years.
- Multivariate linear regression models analyzed predictors of glycemic outcomes.
Main Results:
- Securely attached girls showed higher average HbA1c compared to insecurely attached girls.
- In boys, more insecure parent attachment correlated with higher average HbA1c, increased HbA1c variability, and lower TIR.
- Sex differences in attachment-parenting relationships and their impact on T1D management were observed.
Conclusions:
- Attachment dynamics are significantly associated with glycemic control in children with T1D, with notable sex-specific effects.
- A tailored, sex- and attachment-informed approach is recommended for managing T1D in children.
- Further research with larger samples and more frequent cortisol measurements is needed to elucidate the links between stress, attachment, and T1D outcomes.
Background:
Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D).
Research Design And Methods:
101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes.
Results:
More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = -0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = -8.543, p = 0.002).
Conclusions:
Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D.
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